UMD



00philip merrill college of journalismSupervised Internship ProposalPart 1. Student InformationPlease write legibly.FIRST NAMEMIDDLELASTUNIVERSITY ID NUMBER (E.G. 100000000) EMAILADDRESS DURING INTERNSHIP SEMESTERCHECK APPROPRIATE SEMESTER AND INTERNSHIP:FallWinter (199)SpringSummerYear Students must complete Part 1 and have the site supervisor fill out Part 2.Return to: 1100 Knight HallCollege Park, MD 20742, fax: 301-314-9166If you have questions, please visit our website atgo.umd.edu/MerrillCareerCenter00philip merrill college of journalismSupervised Internship ProposalPart 1. Student InformationPlease write legibly.FIRST NAMEMIDDLELASTUNIVERSITY ID NUMBER (E.G. 100000000) EMAILADDRESS DURING INTERNSHIP SEMESTERCHECK APPROPRIATE SEMESTER AND INTERNSHIP:FallWinter (199)SpringSummerYear Students must complete Part 1 and have the site supervisor fill out Part 2.Return to: 1100 Knight HallCollege Park, MD 20742, fax: 301-314-9166If you have questions, please visit our website atgo.umd.edu/MerrillCareerCenterDAY PHONEEVENING PHONEINTERNSHIPS WILL ONLY BE ACCEPTED FOR CREDIT IF STUDENT RECEIVED A GRADE OF “C” OR HIGHER IN PREREQUISITE COURSES. STUDENTS MUST SUBMIT AN UNOFFICIAL TRANSCRIPT WITH THIS FORM.JOUR 199 (1 credit, grade S/F, requires at least 60 hours during one semester; does not count towards degree.)4228465-3232150042284655778500JOUR 396 (2 credit, graded A-F, and requires at least 90 hours during one semester; degree requirement for journalism majors.)416560012001500JOUR 399 (1 credit, graded A-F, and requires at least 90 hours in at least 10 weeks; degree requirement for journalism majors.)927100-1270000I hereby affirm that I have sought an internship as outlined in this document and that I am cognizant of all dangers inherent in such an internship, and of the basic safety rules for activities connected therewith. I understand that it is not the purpose of the supervised internship course to teach safety rules, nor is it the function of the instructor to serve as the guardian of my safety.In consideration of the opportunity to enroll in the supervised internship course and to participate in the internship, I hereby personally assume all risks in connection with the course and the internship, and I further release the University, its officers, agents and employees, from any and all liability for any injury or damage which may befall me while I am enrolled, including all risks connected therewith, whether foreseen or unforeseen, and further to save and hold harmless the University and its officers, agents andemployees from any claim by me or my family, estate, heirs or assigns arising out of my enrollment and participation in this course and internship.I further state that I am of lawful age and legally competent to sign this affirmation and release; that I understand the terms herein are contractual and not a mere recital; that I have informed myself of the contents of this affirmation and release by reading it before I signed it; and that I have signed it as my own free act.In witness whereof, I have executed this affirmation and release at the Philip Merrill College of Journalism, University of Maryland.STUDENT'S SIGNATUREDATE603639866357Merrill. Launching the Next Era of News398399031750Supervisors, please complete Part 2 of the Supervised Internship Form and return it to your intern.If you have questions, please visit us atgo.umd.edu/MerrillCareerCenter00Supervisors, please complete Part 2 of the Supervised Internship Form and return it to your intern.If you have questions, please visit us atgo.umd.edu/MerrillCareerCenter Part 2. Supervisor InformationPlease write legibly.93853021336000SUPERVISOR’S NAME9385303454400093853067310000TITLE ORGANIZATION ADDRESSBENEFITS:41751252349500417576048704500417576017716500Parking Lunch Honoraria Hourly Wage938530374650041757604191000Other (specify) PHONEFAX93980019875500EMAILSupervisors will evaluate interns twice during the grading period. Please indicate how you would prefer to receive evaluations.*Keep in mind the Fair Labor Standards Act and the additional oversight necessary for unpaid interns.ATTACH INTERNSHIP JOB DESCRIPTION OR SPECIFY DUTIES AND ACTIVITIES BELOW:925195298450093027522479000E-mail: Fax: 399669013208000399669029718000935355-635000BY SIGNING BELOW, I VERIFY THAT I AM A FULL-TIME COMMUNICATIONS PROFESSIONAL AND AGREE TO:provide a valuable learning experience for this interndirectly supervise the intern including regularly scheduled one-on-one meetings, and not delegate to a support-staff memberprovide midterm and final semester written evaluations to the College as requested, and discuss these evaluations with the intern in a timely mannerverify midterm and final semester time sheetsadvise the intern of any risks associated with the internshipon behalf of the sponsoring organization, provide a workplace which meets all Federal, state, and local requirements regarding employmentcomply with all applicable state or federal fair-labor laws, particularly with respect to unpaid interns; and honor the University of Maryland at College Park's non-discrimination code as follows: The University of Maryland is committed to providing educational opportunity to all, and does not discriminate based on race, color, religion, national origin, sex, age, handicap or sexual orientationagree on behalf of my organization that neither the University nor any of its agents or employees shall be in any way responsible for the student's acts or omissions during the internship or for the student's performance of his/her responsibilities. I agree on behalf of my organization to indemnify, hold harmless, and defend (at the election of the University), their employees, agents, successors and assigns with respect to any and all claims, damages, judgments, actions and causes of action arising out of the acts, omissions, or negligence of the sponsor or its agents or employees, including, all costs, expenses and attorney's fees.100520516700500399288016700500SUPERVISOR’S SIGNATUREDATEJOURNALISM COLLEGE COORDINATOR’S SIGNATUREDATEVerification of the above student's registration for credit for this learning experience will be forthcoming upon the conclusion of the University's add/drop period (usually at the end of the first two weeks of classes.) ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download